Photoactivated riboflavin-doped hydroxy apatite nanospheres infiltered in orthodontic adhesives.

To assess micro-tensile bond strength (µTBS), degree of conversion (DC), microleakage (ML) antibacterial efficacy, and adhesive remnant index (ARI) of orthodontic brackets to enamel with different concentrations of photoactivated riboflavin-doped hydroxyapatite (HA) nanospheres (NS) (0%,1%,5% and 10%) and 0.5 wt% RF alone in orthodontic adhesive. Samples were included on the predefined inclusion criteria and positioned up to the cementoenamel junction (CEJ). Hydroxy apatite nanospheres (HANS) commercially bought were doped with RF. Surface characterization of HANS and RF-doped HANS were assessed along with EDX analysis. Samples were grouped based on experimental orthodontic adhesive modification. Group 1: Transbond XT no modification, Group 2: experimental Transbond XT 0.5 wt% RF, Group 3: experimental Transbond XT 0.5 wt% RF-doped 1% HANS, Group 4: experimental Transbond XT 0.5 wt % RF-doped 5% HANS and Group 5: Experimental Transbond XT 0.5 wt% RF-doped 10% HANS. Brackets were placed based on different adhesive modifications and samples underwent thermocycling. Samples were evaluated for µTBS, DC, and ML. The type of failure was assessed using ARI. Adhesive modified and un-modified in four different concentrations (0%, 1%, 5%, and 10%) and 0.5 wt% RF only were used to test efficacy against Streptococcus mutans (S.mutans). The survival rate of S.mutans and ML was determined using the Kruskal-Wallis Test. For the analysis of µTBS, ANOVA was employed, followed by a post-hoc Tukey HSD multiple comparisons test. The highest µTBS and lowest ML were observed in Group 2 experimental Transbond XT 0.5 wt% RF only. The lowest µTBS, highest ML, and lowest DC was seen in Group 5 experimental Transbond XT 0.5 wt% RF-doped 10% HANS. Samples in Group 1 in which Transbond XT was used as adhesive demonstrated significantly the highest microbial count of S.mutans and DC. Photoactivated RF-doped HANS in 1% and 0.5 wt% Riboflavin alone in orthodontic adhesive for metallic bracket bonding improved micro tensile bond strength, ML, DC, and antibacterial scores. RESEARCH HIGHLIGHTS: The highest µTBS and lowest ML were observed in Group 2 experimental Transbond XT 0.5 wt% RF only. The lowest µTBS, highest ML, and lowest DC was seen in Group 5 experimental Transbond XT 0.5 wt% RF-doped 10% HA-NS. Samples in Group 1 in which Transbond XT was used as adhesive demonstrated significantly the highest microbial count of S.mutans and DC.

Satisfaction-Behavior Paradox in Lifestyle Choices: A Cross-Sectional Study of Health Behaviors and Satisfaction Levels in Jazan, Saudi Arabia.

BACKGROUND: Lifestyle choices significantly affect health outcomes in Saudi Arabia, but the relationship between health behaviors and satisfaction is unclear. This study aimed to assess lifestyle choices and associated satisfaction levels among residents in the Jazan region of Saudi Arabia. METHODS: A cross-sectional study was conducted in Jazan, Saudi Arabia, with 3411 participants. Sociodemographic, lifestyle, and satisfaction data were collected using a questionnaire that was completed during interviews. Logistic regression analyses were implemented to examine the relationships between the study variables and factors related to weight, physical activity, and eating satisfaction. RESULTS: The study found that 38.3% of participants were inactive and 77% rarely ate fruits and vegetables. A total of 47.6% were overweight or obese. Weight (71.12%) and eating (71.59%) satisfaction were high despite these health concerns. The satisfaction-behavior paradox was especially evident in diet. Higher income, physical activity, and healthy eating habits were significantly associated with higher satisfaction (OR = 1.49, 95% CI: 1.15-1.93, p = 0.003 for weight satisfaction, OR = 34.74, 95% CI: 25.42-48.35, p < 0.001 for physical activity satisfaction, and OR = 2.08, 95% CI: 1.67-2.61, p < 0.001 for fruit and vegetable consumption). CONCLUSIONS: Lifestyle behaviors and satisfaction in Jazan, Saudi Arabia, are complex. The satisfaction-behavior paradox, especially in diet, reveals a major gap between perceived and actual health. These findings highlight the need for targeted, culturally sensitive interventions that address behavioral change and perception alignment to improve regional public health.

Latent tuberculosis infection and diagnostic performance of the tuberculin skin test among type 2 diabetics in Sana'a city, Yemen.

BACKGROUND: Tuberculosis (TB) is one of the most widespread infectious diseases worldwide, typically persisting in the body as a latent TB infection (LTBI). Patients with type 2 diabetes have an increased risk of LTBI progressing to active TB. Therefore, this study determined the prevalence and predictors of LTBI and assessed the agreement between tuberculin skin test (TST) and interferon-gamma release assay (IGRA) in diagnosing LTBI among type 2 diabetics in Sana'a city, Yemen. METHODS: A cross-sectional study was conducted among 150 type 2 diabetics in private health facilities in Sana'a in 2023. Data about demographics, diabetes-related characteristics, and potential risk factors for LTBI were collected using a structured questionnaire. Patients were then screened for LTBI using TST and IGRA. Univariate analysis was used to identify LTBI-associated risk factors, and multivariable binary logistic regression was used to identify independent predictors of LTBI. The agreement between TST and IGRA for diagnosing LTBI was assessed using Cohen's kappa coefficient (κ). RESULTS: LTBI was prevalent among 29.3% of type 2 diabetics using both types of tests (25.3% with IGRA and 21.3% with TST). Male gender was an independent predictor of LTBI (AOR = 4.4, 95% confidence interval: 1.30-15.08; P = 0.018). However, being employed (AOR = 0.3, 95% CI: 0.09-0.75; P = 0.013) and longer duration since diabetes diagnosis (AOR = 0.3, 95% CI: 0.12-0.98; P = 0.046) were identified as predictors of lower LTBI risk. The agreement between TST and IGRA for the diagnosis of LTBI was 88%, with a good and statistically significant agreement between the two test types (κ = 0.670; P < 0.001). CONCLUSIONS: LTBI is common among type 2 diabetics seeking medical care in Sana'a city, with about one-third of them possibly being latently infected. A higher LTBI risk can be predicted among males, while a lower risk can be predicted among those employed or being diagnosed with diabetes for at least five years. The TST shows good agreement with IGRA in diagnosing LTBI among type 2 diabetics, supporting its continued use as a cost-effective and easily accessible test for diagnosing LTBI in the country.

Prevalence and Determinants of Exclusive Breastfeeding Among Mothers of Children Aged 6-24 Months in the Aseer Region.

Background Exclusive breastfeeding (EBF) is crucial for infant and maternal health, providing optimal nutrition and immune protection for infants while reducing maternal postpartum depression and cancer risk. However, global trends show an early cessation of breastfeeding and the introduction of other foods. This study aims to determine the prevalence and factors influencing EBF among mothers in the Aseer region of Saudi Arabia. Methodology A cross-sectional study using a multistage cluster sampling approach was conducted from January to March 2024 in primary healthcare centers across the Aseer region. Participants included mothers of children aged 6-24 months attending primary healthcare centers for immunizations or routine check-ups. A pretested structured questionnaire, developed after an extensive literature review and expert consultation, was used to interview consenting participants. The questionnaire covered sociodemographic data, obstetric and medical history, child data, EBF practices, maternal knowledge and perception of breastfeeding, counseling about breastfeeding, antenatal care, breastfeeding support, and barriers and motivators of EBF. Results A total of 1,008 eligible mothers were included. Only 131 (13%) fulfilled the World Health Organization criteria for EBF. Moreover, 257 (25.5%) mothers initiated breastfeeding within the first hour after delivery, and 387 (38.4%) exclusively breastfed for six months or more. EBF was less frequent among mothers with higher education (8%, n = 2) compared to those with lower education (23%, n = 23, p = 0.017). EBF was also less frequent among mothers who delivered via cesarean section (7.9%, n = 28) compared to those who had a vaginal delivery (15.8%, n = 103, p = 0.001). Conversely, EBF was more common among mothers with more than five pregnancies (15.8%, n = 45) compared to those with one to two pregnancies (9.4%, n = 37, p = 0.023). EBF was also more common among mothers who had breastfed more than four children (16.7%, n = 39) compared to those who had not (12.1%, n = 49, p = 0.048). Finally, EBF was more common among mothers without postpartum complications (13.4%, n = 131) or whose infants had no birth complications (13.4%, n = 128) compared to their respective counterparts (p = 0.029 and p = 0.048, respectively). Conclusions This study found a low prevalence of EBF in the Aseer region, despite high maternal knowledge and positive perceptions. Factors such as low education, medical barriers, unemployment, and high parity were associated with increased EBF rates. Interventions should focus on improving workplace support and increasing maternal awareness of EBF recommendations.

A Comparative Analysis of the Quality of Root Canal Fillings of In Vivo Studies Conducted in Saudi Arabia and Worldwide: A Systematic Review.

Aim: Root canal treatment (RCT) is a common procedure practiced daily by dentists worldwide. The current systematic review aimed to evaluate and compare clinical studies on the quality of root canal fillings (RCFs) carried out by dentists with different levels of experience conducted worldwide with those conducted specifically in Saudi Arabia (SA). Materials and Methods: A full literature search was conducted in Clarivate Analytics' Web of Science, Elsevier's Scopus, Embase, CINHAL, and PubMed, without a restriction to studies published before January 2015. Also, a manual search was carried out by checking papers that may have been missed during the electronic search. The following keywords were used: [(quality of root canal filling(s)) OR (quality of root canal obturation)) and dental practitioners as (general dental practitioners; final year students; endodontist; specialist) AND (root canal obturation) OR (endodontic treatment)]. Parameters of the quality of RCFs, such as length, density, and taper, were assessed and counted. Results: A total of 13 worldwide and nine SA studies were included in this review, published between 2015 and 2023. Molars were the most treated teeth, at 42.3% and 40.2% for the worldwide and SA studies, respectively. Cases treated by final year students had the highest percentage, at 60.0% for both study groups. The percentages of acceptable quality, with regard to the length, density, and taper of RCFs, were 70.9%, 77.6%, and 84.3%, and 73.2%, 64.6%, and 67.8% for the worldwide and SA studies, respectively. Conclusion: The overall acceptable quality of RCFs was marginally higher in worldwide studies than in SA studies. Both prevalences can be considered as good, which indicates that the quality of RCFs is moving in the right direction.

Intermittent fasting alerts neurotransmitters and oxidant/antioxidant status in the brain of rats.

Several recent studies have attempted to understand how fasting has benefits for body health, especially the nervous system. To evaluate the impact of intermittent fasting on body weight, brain neurotransmitters, brain oxidative stress, and brain-derived neurotrophic factor (BDNF) in several areas of the brain, this study was conducted in rats. Thirty male Wistar rats were randomly divided into two groups. Group 1 (15 rats) served as the control and group 2 (15 rats) underwent intermittent fasting (IF; 24 h) for 1, 7, or 15 days. The findings demonstrated that intermittent fasting significantly reduced body weight. In this sense, brain monoamines and amino acids, namely dopamine, glutamate, aspartate, and oxidative stress markers (malondialdehyde and nitric oxide), decreased significantly after 1 day of IF. However, norepinephrine, serotonin, gamma-amino butyric acid, and glycine increased significantly. Additionally, glutathione levels were markedly elevated in IF. Surprisingly, the neuromodulatory effect of intermittent fasting fluctuates depending on the IF period. To support this fluctuation, BDNF levels increased after 1 day in the hippocampus and decreased after 15 days of intermittent fasting in all areas of the brain tested. In conclusion, our results show that intermittent fasting has beneficial influences on the brain; however, prolonged intermittent fasting can also induce some unfavorable physiological outcomes that prevent optimal neurological function.

A Systematic Review of Questionnaires Assessing Patient Satisfaction in Plastic Surgery: Tools, Topics, and Surgical Types.

Background: Patient satisfaction is crucial for evaluating healthcare services, including plastic surgery. This systematic review aims to analyze questionnaires assessing patient satisfaction in plastic surgery, identifying their strengths and weaknesses to improve outcomes and enhance the quality of care. Methods: A comprehensive literature search was conducted using electronic databases. Studies were included if they were original research articles, written in English, and focused on patient satisfaction questionnaires in plastic surgery. Data extraction and descriptive statistics were used to summarize the data. Results: A total of 105 studies were included. General/overall satisfaction was the most common topic addressed (99.04%). Cosmetic outcomes were the most frequently assessed category (34.3%). Breast reconstruction was the most common procedure (33.3%). Most studies used a combination of generic and procedure-specific questionnaires (45.71%). The most frequently used measurement tools were BREAST-Q and self-developed questionnaires, each accounting for 28.57% and 27.61%. Conclusions: This review provides a comprehensive analysis of patient satisfaction questionnaires in plastic surgery, emphasizing the importance of a holistic approach and well-established, validated tools. The findings contribute to improving plastic surgery outcomes and enhancing the quality of care. Future research should refine assessment tools to address patients' needs and promote patient-centered outcomes in plastic surgery.

Development of Free Fatty Acid (FFA) monitoring device for evaluation of oil samples used for biodiesel production.

Diversion of oil sources for biodiesel production has been gaining importance to meet the environmental concerns and energy demand. The free fatty acid (FFA) content of the feedstock is a significant factor in biodiesel production. The FFA values determine the complexity of the biodiesel production. Until date, an experimental procedure has been used to determine the FFA concentration of an oil source; this method is dependent on titration, which is a laborious process involving significant volumes of chemicals. Hence, in the present study, an attempt was made to develop a device for the identification of FFA of the oils. Waste cooking oil samples subjected to wide range of cooking conditions like cooking time, temperature, type of food are collected from different food outlets. Subsequently, the composition of oil samples and the variation in their quality were analysed using gas chromatography flame ionization detector (GC - FID). Biodiesel is prepared from the oil samples through transesterification and the impact of FFA and their respective methyl esters in the quality and properties have been investigated. The properties of biodiesel were determined as per ASTM standards. The study was further extended to correlate the properties of biodiesel with the composition of the oil from which it was derived. The analysis evidently proved the dependence of biodiesel properties on the FFA percentage and the composition of the oil. The results have been further substantiated with the performance and emission characteristics of internal combustion engine fuelled with the prepared biodiesel samples.

Granulosis rubra nasi from plastic surgery perspective.

Affecting the eccrine glands, granulosis rubra nasi (GRN) is an inherited disorder that manifests itself as redness, sweating, and papules distributed mainly in the center of the face. It is diagnosed clinically and the cornerstone of management is reassurance and education about the benign nature of the condition. A wide array of treatment modalities has been proposed, such as Botox and corticosteroids injections; however curative measures are yet to be discovered. In this paper, we present a case of a 26-year-old man complaining of chronic nose sweating. The case was successfully managed with Botox injections, though we suggested our theory of undercutting the glands through aggressive defatting as part of open rhinoplasty to the patient; he declined our suggested modality. It remains an untested option and caution should be exercised in high-risk patients to avoid compromising blood supply to the skin and risking skin necrosis.

Efficacy of Adenoidectomy versus Tympanostomy on the Otitis Media with Effusion: A Systematic Review and Meta-Analysis.

BACKGROUND: This systematic review and meta-analysis aimed to investigate the current evidence on the efficacy of tympanostomy and adenoidectomy in children with otitis media with effusion in comparison with tympanostomy alone following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MATERIALS AND METHODS: We completed a comprehensive search of PubMed, Web of Science, Scopus and Cochrane Library databases for relevant studies published in the literature with no date restrictions. We collected the results of the databases search and removed duplicated studies by Rayyan QCRI and EndNote Software X8. We used an Excel sheet for screening titles and abstracts, full text and data extraction. For quality assessment, we used Cochrane Handbook of Systematic Reviews of Interventions 5.1.0 using the quality assessment table provided in Part 2 and Chapter 8.5, and quantitative data synthesis was done using Review Manager (RevMan) software version 5.4. RESULTS: The literature search showed 1510 studies, of which five studies were included in data synthesis. The study measured the effect through number of acute otitis media (AOM) episodes, cumulative number of AOM episodes, siblings with Otitis media (OM), hearing level hearing loss scale of the left, and right ears. The pooled effect estimates showed significant difference between tympanostomy with adenoidectomy versus tympanostomy alone in hearing level hearing loss scale of both ears (SMD -0.17, 95% CI [-0.29, -0.05], P -value=0.005). However, the pooled results were not heterogeneous ( P < 0.25, I2 = 24%). CONCLUSIONS: Tympanostomy with adenoidectomy improves hearing compared to tympanostomy alone, but both treatments have similar effects on ear infection rates. Further research with larger samples is needed to confirm these findings and assess long-term benefits.

Management Strategies for Hypertensive Crisis: A Systematic Review.

A hypertensive crisis is defined as a sudden and significant rise in blood pressure. The blood pressure reading is 180/120 mmHg or higher. A hypertensive crisis is a medical emergency. It can lead to a heart attack, stroke, or other life-threatening medical problems. Investigating the management of the hypertensive crisis was the goal of this study. English-language articles were collected from 2010 to 2024 demonstrating the management of the hypertensive crisis. Overall, there were 15 articles. Surveys and analyses of national databases were the most widely used methods (n=15). The scientific studies documented (1) all investigative studies or reports that included a hypertensive crisis diagnosis, (2) data integrity and reproducibility, and (3) management studies. Other studies show that acute severe hypertension in the hospital is associated with high rates of mortality and morbidity, particularly with new or worsening end-organ damage. The problem is linked to poor medical adherence, but alarmingly low follow-up rates are likely to contribute to a high recurrence rate. The treatment of acute severe hypertension varies according to the hospital unit (medical ward or intensive care unit), medication, and blood pressure targets or thresholds. Because of a lack of evidence-based guidance, arbitrary blood pressure control targets are used, or blood pressure targets are crudely extrapolated from guidelines intended primarily for outpatient management. Patients with acute aortic dissection need to be administered intravenous esmolol within 5 to 10 minutes in order to lower their blood pressure right away. The goal is to maintain a systolic reading of less than 120 mm Hg. Vasodilators such as nitroglycerin or nitroprusside may be administered if the blood pressure persists following beta blocking. Intravenous administration of clevidipine, nicardipine, or phentolamine is required; the initial dose is 5 mg, with subsequent doses given every 10 minutes as necessary to achieve the desired reduction in blood pressure.

The Importance of Molecular Biological Analysis for the Laboratory Diagnostic of Homozygous Haemoglobin Malay.

Haemoglobin (Hb) Malay is variant haemoglobin with a ß++ thalassemia phenotype. The prevalence of Hb Malay in the Malaysian population was 5.5%. We describe a 58-year-old male who presented with symptomatic anaemia to the Hospital Universiti Sains Malaysia. Further history revealed that the patient had anaemia since the age of 28, and on regular follow-up at other hospital. Physical examination revealed pallor, jaundice and hepatosplenomegaly. The full blood count and peripheral blood smear showed hypochromic microcytic anaemia with anisopoikilocytosis, and many target cells. High-performance liquid chromatography results showed a ß thalassemia trait. However, the diagnosis does not alight with the patient's condition. Bone marrow aspirate was completed and showed reactive changes and erythroid hyperplasia. A molecular test was then performed for ß globin gene mutation detection using Multiplex Amplification Refractory Mutation System (M-ARMS) PCR method. This revealed the result as homozygous codon 19 mutation or Hb Malay. Therefore, in this case report we would like to highlight the laboratory approaches, the challenges faced by the usual haematological investigations and the importance role of molecular testing in the diagnosis of severe anaemia.

Knowledge, attitude, and practices of pharmacy students in 7 Middle Eastern countries concerning antibiotic resistance: A cross-sectional study.

Addressing antimicrobial resistance (AMR) stands as a major global health challenge threatening humanity. Resolving this issue can be initiated through emphasizing the significance of AMR education among students in health colleges during their undergraduate studies. Hence, the aim of this study is to assess the pharmacy students' knowledge, attitudes, and practices regarding antibiotic resistance in 7 Middle Eastern countries. A cross-sectional study was conducted among undergraduate pharmacy students at universities in Egypt, Jordan, Saudi Arabia, Lebanon, the United Arab Emirates, Qatar, and Kuwait between March 2021 and January 2022. The first section of the questionnaire gathered demographic information. The knowledge section comprised 7 questions. Subsequently, the questionnaire explored participants' attitudes (6 items) and practices (2 items) concerning antibiotic resistance. Mann-Whitney and Kruskal-Wallis tests were used to compare the median knowledge score between different demographic groups. Logistic regression was used to estimate odds ratios, with 95% confidence intervals (CIs) for being more knowledgeable about antibiotic resistance. A 2-sided P < .05 was considered statistically significant. A total of 4265 pharmacy students were involved in this study (Egypt (2249), Jordan (n = 704), Saudi Arabia (n = 531), Lebanon (n = 401), United Araba Emirates (n = 130), Qatar (n = 129), and Kuwait (n = 121)). The median knowledge score for the participating pharmacy students was 5.00 (IQR = 4.00-6.00) out of 7, equals to 71.4% with 4th, and 5th year students and bachelor of pharmacy program students have higher odds of being more knowledgeable about antibiotics resistance compared to other students (P < .05). The majority of the students agreed that antibiotic resistance is increasing, they should be more concerned regarding antibiotic consumption and that government should create more awareness of antibiotic resistance, and that they should have enough knowledge to prevent antibiotic resistance. Around 3 quarters of the students (73.0%) confirmed that they take antibiotic only after getting prescription from their physician and almost half (51.7%) reported that they take antibiotic to manage their fever. The study concluded good educational programs in Middle East pharmacy schools with the need for targeted educational interventions promoting responsible antibiotic stewardship practices among future pharmacists.

Impact of Isotretinoin on Blood Lipids and Liver Enzymes: A Retrospective Cohort Study in Saudi Arabia.

Background: Isotretinoin is an effective treatment for acne but can cause side effects such as changes in blood lipids and liver enzymes. Laboratory monitoring is essential during treatment, but there is variation in monitoring practices. Aim: This study aims to investigate the relationship between isotretinoin therapy and its effects on complete blood count in Saudi Arabia to improve patient outcomes. Methods: The study was a retrospective cohort study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, between January 2016 and December 2020. Following the inclusion and exclusion criteria, 515 patients were randomly selected for the study. The data was analyzed using SPSS, and descriptive statistics and paired samples t-tests were employed to analyze the data. Results: In this study, 515 patients were enrolled. Of these participants, 76.7% (n=395) were females and 23.3% (n=120) were males. The mean age of the study participants was 23.98±7.4 years and ranged between 16 and 65 years. The mean dose of Isotretinoin administered was 27.65±9.6 mg/day, with a range of 10-60 mg/day. The mean BMI of the study participants was 24.3±4.1 kg/m2, ranging from 14.3 to 44.8 kg/m2. Regarding the effect of Isotretinoin on laboratory measures, significant statistical differences were found in hemoglobin measurements (t=-3.379, p=0.001), platelets (t=-3.169, p=0.002), neutrophils (%) (t=3.107, p=0.002), total cholesterol (t=-13.017, p=0.000), AST (t=-6.353, p=0.000), ALT (t=-4.352, p=0.000), HDL (t=2.446, p=0.015), and LDL (t=-12.943, p=0.000). However, there were no significant statistical differences in the measurements of WBC, neutrophils (count), or triglycerides. In the Chi-square analysis and Fisher's Exact test to identify the interaction between BMI, dose, and gender on abnormal lab results, significant interaction was found between participants' BMI and abnormal HDL measurements (p=0.006). Furthermore, there were significant interactions between Isotretinoin dose (either less than 30 mg/day or 30 mg/day or more) and abnormal neutrophil count (p=0.04), abnormal HDL measurements (p=0.010), and abnormal triglycerides measurements (p=0.020). Moreover, a statistically significant interaction was found between participants' gender and abnormal hemoglobin measurements (p=0.006), abnormal total cholesterol (p=0.016), abnormal AST measurements (p=0.001), abnormal ALT measurements (p=0.000), abnormal HDL measurements (p=0.000), and abnormal triglycerides measurements (p=0.007). Conclusion: In conclusion, the study found that isotretinoin therapy has significant effects on several laboratory measures, including hemoglobin, platelets, neutrophils, total cholesterol, AST, ALT, HDL, and LDL. The study also revealed significant interactions between BMI, dose, gender, and abnormal lab results.

Modeling the Clinical and Economic Burden of Therapeutic Inertia in People with Type 2 Diabetes in Saudi Arabia.

INTRODUCTION: Therapeutic inertia in type 2 diabetes, defined as a failure to intensify treatment despite poor glycemic control, can arise due to a variety of factors, despite evidence linking improved glycemic control with reductions in diabetes-related complications. The present study aimed to evaluate the health and economic burden of therapeutic inertia in people with type 2 diabetes in Saudi Arabia. METHODS: The IQVIA Core Diabetes Model (v.9.0) was used to evaluate outcomes. Baseline cohort characteristics were sourced from Saudi-specific data, with baseline glycated hemoglobin (HbA1c) tested at 8.0%, 9.0%, and 10.0%. Modeled subjects were brought to an HbA1c target of 7.0% immediately or after delays of 1-5 years across time horizons of 3-50 years. Outcomes were discounted annually at 3.0%. Costs were accounted from a societal perspective and expressed in 2023 Saudi Arabian Riyals (SAR). RESULTS: Immediate glycemic control was associated with improved or equal life expectancy and quality-adjusted life expectancy and cost savings in all scenarios compared with delays in achieving target HbA1c. Combined cost savings ranged from SAR 411 (EUR 102) per person with a baseline HbA1c of 8.0% versus a 1-year delay over a 3-year time horizon, to SAR 21,422 (EUR 5291) per person with a baseline HbA1c of 10.0% versus a 5-year delay over a 50-year time horizon. Discounted life expectancy and quality-adjusted life expectancy were projected to improve by up to 0.4 years and 0.5 quality-adjusted life years (QALYs), respectively, with immediate glycemic control. CONCLUSION: Therapeutic inertia was associated with a substantial health and economic burden in Saudi Arabia. Interventions and initiatives that can help to reduce therapeutic inertia are likely to improve health outcomes and reduce healthcare expenditure.

Novel composite of nano zinc oxide and nano propolis as antibiotic for antibiotic-resistant bacteria: a promising approach.

This study proposes an innovative approach to combat the escalating threat of antibiotic resistance in bacteria by introducing a novel ZnO-propolis nanocomposite (ZnO-P NCs). The overuse of antibiotics, particularly during events like the COVID-19 pandemic, has intensified bacterial resistance, necessitating innovative solutions. The study employs a cost-effective and controllable biosynthesis method to produce ZnO nanoparticles (ZnO-NPs), with propolis extract crucially contributing to the reduction and stabilization of Zn2+ ions. A biodegradable nano-propolis matrix is then created by incorporating ZnO-NPs, forming the ZnO-P NCs. Structural stability is confirmed through FT-IR and Zeta potential analysis, while nanoscale properties are validated via TEM, SEM, and XRD analyses. The antimicrobial efficacy of various substances, including propolis, nano propolis, ethanolic propolis extract, ZnO-NPs, and ZnO-P NCs, is assessed against Gram-negative and Gram-positive bacteria, alongside a comparison with 28 antibiotics. Among the bacteria tested, Pseudomonas aeruginosa PAO1 ATCC15692 was more sensitive (40 mm) to the biosynthesized nanocomposite ZnO-P NCs than to ZnO-NPs (38 mm) and nanopropolis (32 mm), while Escherichia coli was resistant to nanopropolis (0 mm) than to ZnO-NPs (31 mm), and ZnO-P NCs (34 mm). The study reveals a synergy effect when combining propolis with green-synthesized ZnO-NPs in the form of ZnO-P NCs, significantly improving their efficiency against all tested bacteria, including antibiotic-resistant strains like E. coli. The nanocomposite outperforms other materials and antibiotics, demonstrating remarkable antibacterial effectiveness. SEM imaging confirms the disruption of bacterial cell membranes by ZnO-NPs and ZnO-P NCs. The study emphasizes the potential applications of ZnO-NPs integrated into biodegradable materials and underscores the significance of the zinc oxide-propolis nanocomposite in countering antimicrobial resistance. Overall, this research offers a comprehensive solution to combat multidrug-resistant bacteria, opening avenues for novel approaches in infection control.

Emergency physicians' preferences in bronchodilator delivery for asthma exacerbations: a cross-sectional study.

OBJECTIVE: Asthma is a chronic respiratory disorder characterized by airway inflammation and narrowing often leading to acute exacerbations that necessitate a visit to the emergency department (ED). While life threatening cases usually require bronchodilator delivery by nebulizers, mild to moderate acute asthma exacerbations can be treated by bronchodilators delivered either by metered dose inhalers (MDI). Numerous studies have attempted to compare between the two modalities and have drawn similar conclusions in that both are comparable in efficacy with minimal differences. What is evident, however, is that physicians remain inclined to favor nebulizers in the majority of acute asthma exacerbations. METHODS: In this questionnaire-based study, a survey was distributed to physicians who treat asthma exacerbations to examine demographics, knowledge, beliefs, and current practice in regard to bronchodilator therapy. RESULTS: The majority (90.8%) of physicians prefer short-acting beta agonists via nebulizer, with 9.2% favoring MDI + spacer. Participants include consultants, residents, and specialists across various emergency disciplines. While 90.1% find MDI + spacer equally effective as nebulizers, advantages cited include cost-effectiveness (49.6%), shorter ED stays (63.4%), quicker administration (67.9%), and ease of use (58.8%). Challenges include availability (66.4%) and ineffectiveness in younger patients (45%). Despite this, 65.6% are willing to switch to MDI for initial asthma management in the ED, while 34.4% are resistant. CONCLUSION: Concerns about availability and effectiveness in younger patients remain barriers. However, a significant number are willing to adopt MDIs with spacers, indicating potential for broader use with better availability and training.

Can vacuum-formed retainers maintain arch dimensions and alignment compared to Hawley and fixed bonded retainers after treatment with fixed appliances? A systematic review and meta-analysis.

BACKGROUND: Different types of retention appliances have been proposed over the years, but their effectiveness in maintaining arch dimensions and alignment after orthodontic treatment is still unclear. AIM: To assess the efficacy of vacuum-formed retainers (VFRs) in preserving arch widths, arch length, and anterior alignment in maxillary and mandibular arches, compared to removable Hawley retainers (HRs) or fixed bonded retainers (FBRs). Search methods: unrestricted literature search of five major databases up to March 2024. SELECTION CRITERIA: randomized/non-randomized clinical studies comparing VFRs to removable HRs or FBRs. DATA COLLECTION AND ANALYSIS: after duplicate study selection, data extraction, and risk of bias assessment, random effects meta-analyses of standardized mean differences and their 95% confidence intervals were performed, followed by meta-regressions, sensitivity analyses, and assessment of the quality of evidence with GRADE. RESULTS: Twenty-two prospective studies (4 non-randomized and 18 randomized controlled trials) involving 1797 patients (mean age 17.01 years, 38.3% males) were included. No significant differences were found in the intercanine width, intermolar width, and arch length between VFRs and HRs, in both arches (P > 0.05). However, VFRs were statistically more effective than HRs in terms of Little's irregularity scores (LII) in the maxilla (eight studies; SMD = -0.42; 95% CI: -1.03 to -0.09; P = 0.02; I2 = 73.4%) but not in the mandible (P = 0.12). No significant differences were reported for all considered outcomes between VFRs and FBRs in in both arches (P > 0.05), except for lower LII, where VFRs were significantly less efficient (eight studies; SMD = 1.49; 95% CI = 0.26-2.7; P = 0.02; I2 = 93%). Follow-up times, risk of bias, and wire type (of FBRs) did not show statistically significant effects on outcome variables. Sensitivity analyses showed robustness of the findings for including non-randomized and postretention studies. The certainty in these estimates was from moderate to low due to the risk of bias and inconsistency. CONCLUSIONS: Low to moderate quality evidence indicates that VFRs are as effective as HRs in maintaining arch widths, length, and alignment. Low-quality evidence found similar efficacy between VFRs and FBRs, with FBRs being statistically more effective at maintaining lower arch alignment, but the difference was not clinically significant. REGISTRATION: PROSPERO registration (CRD42024518433).

Prevalence and burden of loneliness in COPD: A systematic review and meta-analysis.

BACKGROUND: Loneliness poses significant public health concerns on a global scale. Being alone and lacking social connections have been proven to impact prognosis and response to treatment in different diseases, including COPD. Yet, the prevalence and burden of loneliness on COPD outcomes remain unclear. METHODS: Various relevant databases were systematically searched in March 2024. The quality of the studies included was assessed using a modified Newcastle-Ottawa Scale. The random effect model was used to compute the pooled prevalence and associated 95 % confidence intervals (95%CI) of loneliness and living alone in COPD patients. RESULTS: After reviewing 256 studies, 11 studies, including 4644 COPD patients, met the inclusion criteria and were included in the systematic review. Of the included studies, 5/11 (45.5%) reported the prevalence of loneliness or lone living among COPD patients and were included in the meta-analysis. The prevalence of loneliness and lone living among COPD patients was 32% (95% CI = 16%-48%) and 29% (95% CI = 16%-41%), respectively. The Three-item UCLA loneliness scale was the most often used loneliness assessment tool (5/11, 45.5%). Loneliness and lone living were associated with poor outcomes, including emergency department visits, readmissions, depression, and reduced pulmonary rehabilitation response. CONCLUSION: Despite one-third of COPD patients experiencing loneliness, researchers have not consistently documented its impact on COPD outcomes. More studies are needed to assess the impact of loneliness on COPD and how to mitigate the negative effects on patients' outcomes.

Effects of exercise on autonomic cardiovascular control in individuals with chronic, motor-complete spinal cord injury: an exploratory randomised clinical trial.

STUDY DESIGN: Secondary analysis of a clinical trial. OBJECTIVE: To assess the impact of 6 months of arm cycle ergometry training (ACET), or body weight-supported treadmill training (BWSTT), on autonomic cardiovascular responses to a laboratory sit-up test (SUT) in individuals with chronic (≥1-year post-injury) spinal cord injury (SCI). SETTING: Tertiary Rehabilitation Centre, Vancouver, Canada. METHODS: Sixteen individuals with motor-complete (American Spinal Injury Association Impairment Scale A-B) SCI between the fourth cervical and sixth thoracic spinal cord segments, aged 39 ± 11 years, were assessed. Participants were randomized to receive 72 sessions of moderate-to-vigorous intensity ACET (n = 8) or passive BWSTT (n = 8). Changes in mean arterial pressure (finger plethysmography), hemodynamics (Modelflow® method), and heart rate/heart rate variability (HR/HRV; electrocardiography) were measured in response to a  SUT before and after 6 months of exercise training. Spontaneous cardiovagal baroreflex sensitivity (cvBRS) was assessed using the sequence method. RESULTS: Neither ACET nor BWSTT impacted hemodynamic responses to SUT or the incidence of orthostatic hypotension (all P > 0.36). ACET increased HR (P < 0.01, ηp2 = 0.34) and high frequency (HF) power HRV responses (P < 0.01, ηp2 = 0.42) to SUT following 6 months of training while BWSTT did not. Consistent with this, cvBRS improved (P < 0.05, ηp2 = 0.16) only following ACET. Improvements in cvBRS were correlated with both the HR (r = 0.726, P < 0.0001) and HF power (r = -0.484, P < 0.01) responses to SUT. CONCLUSION: Six months of ACET, but not BWSTT, improved cardiovagal baroreflex control of HR but had no effect on BP responses to SUT in individuals with chronic, motor-complete SCI. SPONSORSHIP: Canadian Institutes of Health Research (CIHR) CLINICAL TRIAL REGISTRATION: NCT01718977.